Self-perception of dietary quality and adherence to food groups dietary recommendations among Mexican adults.

BACKGROUND: Mexicans' adherence to food group's dietary recommendations is low and an inaccurate self-perception of dietary quality might perpetuate this low adherence. Our aim was to compare the intake and the adherence to the dietary recommendations for several food groups, subgroups, and to an overall Mexican Diet Quality Index (MxDQI), among those that perceived their diet as healthy vs. those that did not. METHODS: We analyzed data from 989 subjects 20-59 y old from the nationally representative Mexican National Health and Nutrition Survey 2016. Dietary intake was collected with one 24-h recall and a repeated recall in 82 subjects. Self-perception of dietary quality was evaluated with the following question "Do you consider that your diet is healthy? (yes/no)". We used the National Cancer Institute method to estimate the usual intake. We compared the mean intake adjusted by sociodemographic variables and the percentage of adherence according to the self-perception of dietary quality among the whole sample and in sociodemographic subpopulations. RESULTS: Sixty percent perceived their diet as healthy, and their adherence to recommendations was low [20% for fruits and vegetables, < 8% for legumes, seafood and SSBs, and ~ 50% for processed meats and high in saturated fat and/or added sugar (HSFAS) products]. The mean number of recommendations they met was 2.8 (out of 7) vs. 2.6 among the rest of the population (p > 0.05), and the MxDQI score was 40 vs. 37 (out of 100 points). The only food groups and subgroups with a statistically significant difference between those that perceived their diet as healthy vs. unhealthy were fruits [38 g/d (95% CI 3, 73)], fruit juices [27 g/d (95% CI 2, 52)], industrialized SSBs [- 35 kcal/d (- 70, - 1)] and salty snacks [- 40 kcal/d (- 79, - 1)]. Other differences were small or inconsistent across subgroups of the population. CONCLUSIONS: Those that perceived their diet as healthy only had a slightly healthier diet than the rest of the population, moreover, their adherence to recommendations was very low. Hence, it is necessary to improve their nutrition knowledge.

Consumo de agua, bebidas azucaradas y uso de bebederos en secundarias del Programa Nacional de Bebederos Escolares de la Ciudad de México.

Objetivo. Describir prácticas de consumo de bebidas y uso de bebederos escolares en estudiantes de secundarias del Programa Nacional de Bebederos Escolares (PNBE). Material y métodos. Estudio transversal descriptivo, con enfoque mixto en secundarias públicas (turnos matutino y vespertino). Se indagó el consumo de agua y bebidas azucaradas, utilización de bebederos escolares y barreras-facilitadores para el consumo de agua. Resultados. Se entrevistaron 617 estudiantes (11 a 16 años); 51.5% fueron hombres. El consumo promedio de agua (568.9 ml; IC95%: 470.7-667.1) y bebidas azucaradas (143.4 ml; IC95%:124.0-162.7) fue similar entre hombres y mujeres. En el turno matutino las mujeres presentaron una menor probabilidad de hacer uso de los bebederos en comparación con los hombres (p=0.032). Hombres y mujeres desconfían del agua de los bebederos. Conclusiones. Se requieren acciones integrales para favorecer el consumo de agua y el uso de los bebederos en las secundarias del PNBE.

Compliance with nutrition standards in Mexican schools and their effectiveness: a repeated cross-sectional study.

BACKGROUND: Mexico approved mandatory nutrient-based standards for foods sold in schools in 2011. The aim of this study was to analyse the association between compliance with nutrition standards for foods sold in schools and children's school snacks. METHODS: Data came from three surveys representative of Mexican elementary schools in 13 states and their students (2012, 2013 and 2015); n = 645 children from N = 99 different schools. Information on foods sold in schools and snacks consumed by children was collected through direct observation. Compliance with the standards was defined as the proportion of foods sold in school which met nutrition criteria established by the standards. Snacks were classified as healthy if they contained at least one fruit or vegetable and had no sugar-sweetened beverages. Robust logistic regression models for cross-sectional and repeated surveys aggregated at the school-level were fitted to quantify the association between school compliance with standards and healthy snacks. RESULTS: On average across waves 27% of foods sold complied with nutrition standards; 18% of children consumed a healthy snack. For snacks purchased in school, a 10% increase in school compliance with the standards was associated with a 32% increase in the odds of a healthy snack (OR = 1.32; 95%CI 1.09,1.61); no association was observed for snacks brought from home. The odds of a healthy snack increased over time in schools where compliance with the standards improved (OR = 3.89; 95%CI 1.47,10.31) but not in those where compliance remained constant or decreased. CONCLUSIONS: Only a small proportion of children are eating healthy snacks in school. School compliance with standards increases the likelihood of a healthy snack if it is bought at school. Our findings support better implementation of the standards and additional strategies to enhance the policy to achieve its aim of reducing childhood obesity.

[Perception of body weight and of the probability of developing obesity in Mexican adults]. / Percepción del peso corporal y la probabilidad de desarrollar obesidad en adultos mexicanos.

OBJECTIVE: To document the perception of body weight, the variables that are associated with a correct perception of it and with the perception about the probability of developing obesity at short-term in Mexican adult population. MATERIALS AND METHODS: We used data from the Perception of obsesity, eating behavior and physical activity questionnaire (POCAA, by its Spanish acronym), as well as household and anthropometric measurements obtained at Ensanut MC during May and October of 2016. RESULTS: More than 90% of the population tend to underestimate their weight; 32% of the population said that they would be very likely to develop obesity at short-term; more than 90% considered that suffering from obesity is very serious. Having a correct perception of body weight and being overweight or obese by BMI, were positively related to the perception of developing obesity at short-term. CONCLUSIONS: It is very relevant that individuals, regardless of the state of their weight, have an accurate perception of their body and the consequences to their health.

OBJETIVO: Documentar la percepción del peso corporal, las variables que se asocian con una percepción correcta de éste y la percepción de la probabilidad de desarrollar obesidad a corto plazo en población adulta mexicana. MATERIAL Y MÉTODOS: Se utilizaron datos de los cuestionarios de percepción de obesidad, comportamiento alimentario y actividad física (POCAA), y de hogar y antropometría obtenidos en la Ensanut MC, durante mayo y octubre de 2016. RESULTADOS: Más de 90% de la población tiende a subestimar su peso. El 32% de la población refirió que sería muy probable que desarrollara obesidad; más de 90% consideró que padecer obesidad es grave. El tener una percepción correcta del peso corporal y tener sobrepeso u obesidad por IMC se relacionaron con la percepción de desarrollar obesidad a corto plazo. CONCLUSIONES: Resulta cada vez más relevante que los individuos, independientemente del estado de su peso, tengan una percepción precisa de su cuerpo y las consecuencias del sobrepeso en su salud.

Methodology for estimating dietary data from the semi-quantitative food frequency questionnaire of the Mexican National Health and Nutrition Survey 2012.

OBJECTIVE:: To describe the methodology used to clean up and estimate dietary intake (DI) data from the Semi-Quantitative Food Frequency Questionnaire (SFFQ) of the Mexican National Health and Nutrition Survey 2012. MATERIALS AND METHODS:: DI was collected through a shortterm SFFQ regarding 140 foods (from October 2011 to May 2012). Energy and nutrient intake was calculated according to a nutrient database constructed specifically for the SFFQ. RESULTS:: A total of 133 nutrients including energy and fiber were generated from SFFQ data. Between 4.8 and 9.6% of the survey sample was excluded as a result of the cleaning process.Valid DI data were obtained regarding energy and nutrients consumed by 1 212 pre-school children, 1 323 school children, 1 961 adolescents, 2 027 adults and 526 older adults. CONCLUSIONS:: We documented the methodology used to clean up and estimate DI from the SFFQ used in national dietary assessments in Mexico.

Validity of a food frequency questionnaire to assess food intake in Mexican adolescent and adult population.

OBJECTIVE:: To assess the validity of a 140-item semiquantitative food frequency questionnaire (SFFQ), in Mexican adolescents and adults. MATERIALS AND METHODS:: Dietary intakes using a SFFQ and two 24-hour dietary recalls (24DRs), in nonconsecutive days during the same week were measured from 178 adolescents and 230 adults participating in the Mexican National Health and Nutrition Survey-2012.Validity was evaluated using correlation coefficients (CC),deattenuated CC, linear regression models, cross-classification analysis, and the Bland-Altman method. RESULTS:: In adults, deattenuated correlation coefficients between the SFFQ and the 24DRs ranged from 0.30 for folate to 0.61 for saturated fat. In addition, 63% adults and 62% adolescents were classified in the same and adjacent quartile of nutrient intake when comparing data from SFFQ and 24DRs. CONCLUSIONS:: The SFFQ had moderate validity for energy, macronutrients and micronutrients. It also had good validity to rank individuals according to their dietary intake of different nutrients.

[Dietary diversity and nutrient intake in children 24 to 59 months old and their association with food insecurity]. / Diversidad de la dieta y consumo de nutrimentos en niños de 24 a 59 meses de edad y su asociación con inseguridad alimentaria.

OBJECTIVE: To assess dietary diversity (DD) and adequacies of energy and nutrients intake of Mexican children two to four years old according to the level of food insecurity (FI) at household. MATERIALS AND METHODS: Information of 955 Mexican children aged 24-29 months and their households from Ensanut 2012 were included. Dietary data were obtained with a food frequency questionnaire. An index of DD and adequacies of energy and nutrients were estimated. Adjusted prevalences of DD were estimated according to the classification of FI at home using the Latin American and Caribbean Food Safety Scale. RESULTS: Children living in severe FI had the highest proportion of low DD (53.6%) compared to those living in food security. Children with moderate and severe insecurity did not reach the recommended energy intake. CONCLUSION: The DD, energy and nutrients intake in Mexican children are associated to FI. It is important to improve access to foods that provide more diversity to the diet and which are difficult to obtain due to their cost.

Consumption of fruits and vegetables and health status of Mexican children from the National Health and Nutrition Survey 2012.

OBJECTIVE: To characterize the current consumption of fruits and vegetables based on the international recommendations, as well as its relationship to certain variables of interest in Mexican children aged 6 to 12 years. MATERIALS AND METHODS: Adherence to the international recommendations for the consumption of fruits and vegetables was estimated based on data from the 2012 National Health and Nutrition Survey (Ensanut 2012). Logistic regression models were developed. RESULTS: Only 34.4% of children met the recommendations. Their age (years) (OR:074; p< 0.01) and the fact that they lived in the Central (OR:2.48; p< 0.01) or Southern (OR:2.66; p< 0.01) regions of Mexico or in Mexico City (OR:2.37; p< 0.01) versus the Northern region were significantly associated with adherence. An interaction was observed between the educational level of the head of the family and his or her kinship with the child. CONCLUSIONS: Only 3 out of every 10 Mexican children meet the recommendations; therefore, the implementation of a public policy with the appropriate legislation, financing and regulation is required.

Effects of an intervention strategy for school children aimed at reducing overweight and obesity within the State of Mexico.

OBJECTIVE: This study explored the intervention effect of the "Nutrition on the Go" strategy on the prevalence of overweight and obesity (OW+O), according to the role played by different patterns. MATERIALS AND METHODS: Pattern Groups (PG) were determined based on schools' food availability and other variables at individual level: nutrition knowledge, physical activity, socioeconomic level and self-efficacy, using an ecological approach. The PG classification was achieved using Ward's cluster method. RESULTS: The prevalence of OW+O was higher in PGI (intermediate food availability and high socioeconomic index [SEI]) compared to PG 2 (high availability of food and lower SEI) and PG 3 (low availability of food and medium SEI) with a lower prevalence (p<0.00I). The PG-intervention interaction showed differences for PG 3 (p=0.066), the stage-PG interaction showed differences between PGs I and 3 (p=0.014) and between PGs 2 and 3 (p=0.055). CONCLUSIONS: Differences between PGs have important implications for the prevalence of OW+O.

Effectiveness of a diet and physical activity promotion strategy on the prevention of obesity in Mexican school children.

BACKGROUND: Overweight and obesity in children in Mexico was among the countries with the highest prevalence's in the world. Mexico currently has few innovative and comprehensive experiences to help curb the growth of this serious public health problem. Therefore, the aim of this study is to assess the effectiveness of a nutrition and physical activity strategy, called "Nutrition on the Go" ("nutrición en movimiento") in maintaining the BMI values of school children in the State of Mexico. METHODS: A two-stage cluster trial was carried out. Sixty schools were selected in the State of Mexico, of which 30 were randomly assigned to the intervention group (IG) and 30 to the control group (CG). A total of 1020 fifth grade school children participated. The intervention strategy aimed to decrease the energy content of school breakfasts and include fruits and vegetables, as well as increase physical activity and the consumption of water during the time spent at school. The strategy was implemented over a 6-month period. RESULTS: The estimated probability (EP) of obesity between baseline and the final stage for the IG decreased 1% (Initial EP = 11.8%, 95%CI 9.0, 15.2, final EP = 10.8, 95%CI 8.4, 13.) For the CG, the probability increased 0.9% (baseline EP = 10.6%; 95%CI 8.1, 13.7; final EP = 11.5, 95%CI 9.0, 14.6). The interaction between the intervention and the stage is the average odd time corrected treatment effect, which is statistically significant (p = 0.01) (OR = 0.68, 95%CI 0.52, 091).This represents the interaction between intervention and stage, which is highly significant (p = 0.01) (OR = 0.68; 95%CI 0.52, 091). In addition, girls had a protective effect on obesity (OR = 0.56; 95%CI 0.39, 0.80). CONCLUSIONS: The intervention strategy is effective in maintaining the BMI of school children.

[Obesity in Mexican school age children is associated with out-of-home food consumption: in the journey from home to school]. / La obesidad en niños mexicanos en edad escolar se asocia con el consumo de alimentos fuera del hogar: durante el trayecto de la casa a la escuela.

The objective of our study was to evaluate the association between consumption of food during the journey from home to school and back, with overweight and obesity, in a nationwide representative sample of school children. We assessed consumption outside the home in 9537 children, with information on availability and consumption of selected groups of food and beverages. Height, weight, total energy consumption, and sociodemographic variables were also obtained. We developed logistic regression models, and tested interactions with sociodemographic variables. The results of our study show that the prevalence of overweight and obesity was positively associated with dairy consumption in girls (OR:1.70; p = 0.01), as well as fried snacks consumption in school children living in Mexico City (OR: 1.68; p = 0.06). Consumption of fruits and vegetables in medium and high socioeconomic levels was negatively associated with the prevalence of overweight and obesity (OR: 0.54; p = 0.01 and 0.59; p = 0.07, respectively). We concluded that children during their stay away from home have a high availability of energy dense foods, which can influence their consumption and contribute to the development of overweight and obesity, so it is important to investigate this association in prospective studies.

Sugar-sweetened beverages consumption and BMI in Mexican adolescents: Mexican National Health and Nutrition Survey 2006.

OBJECTIVE: To evaluate the association between the consumption of sugar-sweetened beverages (SSBs) and body mass index (BMI) in Mexican adolescents. MATERIAL AND METHODS: We analyzed the data of 10 689 adolescents (ages 10 to 19 years old) who participated in the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006). Consumption of SSBs (i.e. sodas, fruit beverages and sugar beverages) was evaluated by means of a semi-quantitative food frequency questionnaire. BMI was calculated (kg/m(2)). RESULTS: Mean age was 13.8 +/- 2.7 years. Fifty percent were females. Mean BMI was 21.7 +/- 4.5. Thirty percent of adolescents were overweight or obese. Ninety percent of adolescents consumed at least one SSB during the 7 days before the interview. The median consumption of SSBs was 0.89 portion per day. Multiple-linear regression analysis showed that for each portion of sodas consumed, a 0.17-point increase in BMI was observed in boys after adjusting for confounders (95% CI; 0.02-0.32, p 0.03). Positive interactions of SSB consumption with age and time watching TV were observed in boys. CONCLUSIONS: Consumption of sodas was positively associated with BMI in Mexican boys.

Methodology for the analysis of dietary data from the Mexican National Health and Nutrition Survey 2006.

OBJECTIVE: To describe the methodology for the analysis of dietary data from the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006) carried out in Mexico. MATERIAL AND METHODS: Dietary data from the population who participated in the ENSANUT 2006 were collected through a 7-day food-frequency questionnaire. Energy and nutrient intake of each food consumed and adequacy percentage by day were also estimated. Intakes and adequacy percentages > 5 SDs from the energy and nutrient general distribution and observations with energy adequacy percentages < 25% were excluded from the analysis. RESULTS: Valid dietary data were obtained from 3552 children aged 1 to 4 years, 8716 children aged 5 to 11 years, 8442 adolescents, 15951 adults, and 3357 older adults. CONCLUSIONS: It is important to detail the methodology for the analysis of dietary data to standardize data cleaning criteria and to be able to compare the results of different studies.

Energy and nutrient intake in Mexican adolescents: analysis of the Mexican National Health and Nutrition Survey 2006.

OBJECTIVE: To describe energy and nutrient intake and adequacy percentages in Mexican adolescents included in the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006) as well as the proportion of population at risk of dietary inadequacy. MATERIAL AND METHODS: Data were analyzed from 7-day food-frequency questionnaires for 8442 male and female adolescents 12-19 years old. Energy and nutrient adequacies as percentage of the Estimated Average Requirement were calculated and comparisons were done by region, residence area, and socioeconomic status (SES). RESULTS: Energy intake was 1903 kcal [adequacy percentage (AP=75%)] in boys, and 1 571 kcal (AP=79.2%) in girls. Intake of most nutrients (zinc, iron, vitamin C and A) was lower in subjects of low SES, living in the southern region and in rural areas. CONCLUSIONS: The rural area, the southern region, and the lower socioeconomic status show the lowest intakes and percentages of nutrient adequacy for both male and female adolescents, in particular vitamin A, folates, heme iron, zinc, and calcium.

Design of an educational strategy based on Intervention Mapping for nutritional health promotion in Child Care Centers.

Early childhood is a critical period for instilling healthy habits to prevent overweight and obesity. This paper describes the development of an educational intervention for the promotion of healthy eating and physical activity among two-to-four-year-old children in public child care centers (CCCs) in Mexico City. Following the Intervention Mapping (IM) protocol, we developed the Bright Futures multidisciplinary intervention. First, a formative research process to identify the personal and environmental determinants of childhood overweight and obesity, behavioral outcomes and performance objectives was conducted. Then, a matrix of change objectives by intersecting the performance objectives with the determinants was integrated. Bright Futures lasted six months and included 24 weekly sessions, each composed of five phases: warm-up, theory, active movements, relaxation, and hydration. Ad hoc interactive teaching materials focused on recreational activities, and formulated plans for the adoption, implementation and process/impact evaluation of the intervention was developed. IM successfully guided the design of a theory-driven and evidence-based intervention for children in CCCs within a socio-ecological and participatory planning framework. This is one of the first studies in Mexico to use IM in the context of CCCs.

Promoting fruit, vegetable and simple water consumption among mothers and teachers of preschool children: An Intervention Mapping initiative.

For preschool children, mothers and teachers are the principal models and promoters of fruit, vegetable and simple water consumption at home and school, respectively. However, the daily intake of these food and drink items falls below recommended standards among Mexican adults, posing a high risk of non-communicable diseases such as overweight and obesity across all age groups in the country. The objective of this article is to describe the design, implementation and evaluation of an educational initiative conducted in a Mexican locality with the aim of promoting the consumption of fruits, vegetables (FVs) and simple water (SW) among preschoolers through the influence of their mothers and teachers. We used the Intervention Mapping methodology with qualitative and quantitative components. Mothers attended eight theoretical and practical sessions and two school meetings, while teachers were offered two workshops. Our results revealed positive changes among both groups: participants took greater interest in healthy nutrition, increased their purchase, preparation and intake of FVs and SW and promoted their consumption. This confirms that it is possible to achieve favorable changes in eating habits among those who participate in educational initiatives in Mexico.

Ferrous gluconate and ferrous sulfate added to a complementary food distributed by the Mexican nutrition program Oportunidades have a comparable efficacy to reduce iron deficiency in toddlers.

OBJECTIVE: To assess the efficacy of ferrous sulfate (FS) and ferrous gluconate (FG) as fortificants for a complementary baby food (Nutrisano) to improve the iron status and to reduce the prevalence of anemia in toddlers. PATIENTS AND METHODS: Toddlers 12 to 30 months old were randomly assigned to receive either of 3 versions of Nutrisano fortified with FS or FG or not fortified (CG) for 6 months. In final blood samples, the concentrations of hemoglobin, serum ferritin, and soluble transferrin receptors (sTfR) were determined. The effects of treatment on final hemoglobin, ferritin, and sTfR were assessed by multivariate analysis. RESULTS: No significant changes in hemoglobin were observed within or among treatment groups. The prevalence of high sTfR decreased 7.1 percentage points in FG, increased 13.1 percentage points in FS, and increased 0.7 percentage points in CG (P>0.05). In an interaction between treatment and total intake of Nutrisano on the concentration of ferritin, sTfR, and total iron body stores, adjusted means of serum ferritin in the medium tertiles of intake of Nutrisano for FS (P=0.05) and in the higher and medium tertiles for FG were higher (P=0.001), and adjusted means of sTfR were significantly lower (P<0.001), than the respective lower tertile of intake. CONCLUSIONS: Fortification of Nutrisano with FG has an acceptable level of beneficial effect on markers of iron status. The satisfactory efficacy and other sensory data has led to the political decision to substitute hydrogen-reduced iron, used formerly as a fortificant, with FG. Studies to assess the effectiveness of the reformulated Nutrisano are in order.

Dietary intake and adequacy in Mexican preschool children: National Health and Nutrition Survey 2012.

OBJECTIVE: to estimate energy, nutrient intake and diet adequacy in preschool-aged children based on data from the Mexican National Health and Nutrition Survey 2012. MATERIAL AND METHODS: dietary data in children < 5 years (n = 1,212) collected through a Semi-quantitative Food Frequency Questionnaire (SFFQ) were analyzed. Energy and daily nutrient intakes and adequacies were calculated comparing by sociodemographic characteristics. RESULTS: median daily energy intake was 1,252 kcal (adequacy 104%). Adequacies above 100% were observed for calcium, zinc, vitamin C, folate, vitamin B12, vitamin A and median of saturated fat. Low percent adequacies were observed for fiber, iron, polyunsaturated fat and vitamin D. Intakes were lower in the southern region compared to other regions. Most intakes and adequacies were higher in urban compared to rural areas, but fiber had the opposite trend. Indigenous children had low intakes and percent adequacies. CONCLUSIONS: risks of dietary deficiencies and excess are present in Mexican preschool-aged children, with marked differences across sociodemographicstrata.

Consumption of foods and beverages in elementary schools: Results of the implementation of the general guidelines for foods and beverages sales in elementary schools in Mexico, stages II and III.

The Mexican government developed the General Guidelines for the dispensing or distribution of foods and beverages at food sales in elementary schools (Guidelines). The objective is to evaluate the consumption of food and beverages during school hours, in two different stages of the implementation of the Guidelines: stages II (2011-2012) and stage III (2012-2013) in 565 elementary school students. We constructed three categories of consumption according to the origin of food: Home, food brought from home; School, food purchased at school and Both, food from home and food purchased at school. The main results showed that there are differences in both stages in energy intake according to the foods' origin; the category of School has the lowest energy and macronutrients consumption, as well as the closer compliance with de Guidelines recommendations in both stages, while the category of Both has a higher consumption and the less compliance with the Guidelines. This may be indicating an improvement in school guidelines and it is also reflecting the need to reinforce orientation for a healthy diet with respect to foods brought from home. It is necessary to continue with periodic evaluations to measure fulfillment with the Guidelines.

Does the Mexican sugar-sweetened beverage tax have a signaling effect? ENSANUT 2016.

OBJECTIVE: To evaluate the potential signaling effect of the Mexican tax on sugar-sweetened beverages (SSBs) by analyzing the association between awareness of and opinions about its effectiveness with current consumption of taxed SSBs and with a self-reported change in consumption of SSBs since the implementation of the tax. We also examined the association between psychosocial and environmental determinants of SSB consumption with current consumption of taxed SSBs and with a reported change in consumption of SSBs. METHODS: Cross-sectional analyses of survey and food-frequency questionnaire data from the Mexican National Health and Nutrition Survey 2016. Participants were Mexican adults (20-59 years, N = 6,650). Logistic regression was used to evaluate the probability of a person reporting a decrease in SSB consumption, given their awareness of the tax, opinion about its effectiveness, psychosocial (SSB health-related beliefs, self-efficacy, and liking of SSBs) and environmental (availability of potable water) determinants. Multiple linear regression analysis was utilized to examine the association between the aforementioned factors and current consumption of taxed SSBs. RESULTS: Compared with adults not aware, adults who were aware of the SSB tax were more likely (OR = 1.30) to report a decrease in SSB consumption (p = .012). In urban areas, adults aware of the tax drank a significantly lower amount of taxed SSBs (-15.7%; p = .023) than those not aware. Self-efficacy and liking of SSBs were significantly associated with a reported decrease in consumption and with current consumption (p < .001), while health beliefs and availability of potable water were not significantly associated with either reported change in SSB consumption or current consumption of taxed SSBs. CONCLUSIONS: Implementation of an SSB tax accompanied by highly visible campaigns may further influence the impact of taxes on SSBs consumption. Future public health and nutrition education campaigns designed to increase knowledge and enhance motivation should be complemented by programs to assist individuals develop self-efficacy and self-regulation skills.